Objective To evaluate the efficacy of endovascular stent-graft placement for the treatment of Debakey Ⅲ type aortic dissection. Methods From June 2001 to July 2006, 31 patients with Debakey Ⅲ type aortic dissection were diagnosed by contrast-enhanced CT scan. Vascular access was obtained through the right or left femoral artery after arteriotomy and stent-graft was deployed into the true lumen to occlude the primary entry tear. Immediate aortography was performed after the procedure and the follow-up data of CT scan were evaluated. Results Stent-graft deployment was successfully performed in all the patients. Immediate aortography after the procedure showed no leakage in 27 patients and minor leakage in 4. After the operation, one patient showed paraplegia, and one developed left arm ischemia. No stent movement or organ ischemia was found at the early postoperative stage in the other patients. Six months after the operation, in all the 31 patients, contrast-enhanced CT scan showed the disappearance of the false lumen and thrombosis at the level of the stent; and the minor leakage of was improved in the 4 patients. Four years after the operation, one patient developed severe internal leakage at the approximal end of the stent, and was treated by thoracotomy. Conclusions Endovascular stent-graft placement is effective for the treatment of Debakey Ⅲ type aortic dissection. However, further studies are needed to evaluate its long-term outcomes.

Acute massive pulmonary thromboembolism after pneumonectomy usually results in death if not diagnosed early and treated aggressively.It was a case of acute embolism in the main pulmonary ar-tery with thrombus following right pulmonary wedge resection.Diagnosis was made clinically and with computerized tomography before emergency surgery.Thromboembolectomy was successfully performed on cardiopulmonary bypass and the patient was subsequently discharged home after uneventful recovery.Al-though the patient had no previous history of thrombosis,he took high dose of warfarin for anticoagulating postoperatively,which suggested that the patient with pulmonary embolism attack may be associated with the hypercoagulable state of his own.

Objective To evaluate the value of ultrasound-measured changes in diaphragmatic excursion (DE) in predicting successful weaning from mechanical ventilation during the spontaneous breathing trial (SBT).Methods Sixty-three patients of both sexes,who were mechanically ventilated for more than 24 h and screened for ascertained readiness to wean,aged 45-64 yr,were enrolled in the study.Bilateral DE was measured using ultrasound at 0,10 and 30 min of SBT.The patients who successfully completed 30 min of SBT were extubated.The patients were divided into either success group or failure group according to whether or not weaning was successful.Receiver operating characteristic (ROC) curves were used to evaluate the value of bilateral △DE30-10 in predicting successful weaning.Results There were 48 cases in success group and 15 cases in failure group.Bilateral △DE30-10 was significantly higher in failure group than in success group (P＜0.05).The area under the ROC curves of the right △DE30-10 in predicting successful weaning was 0.958,＜0.175 cm was used to predict successful weaning,and the sensitivity and specificity were 93.3％ and 87.5％,respectively.The area under the ROC curves of the left △DE30-10 in predicting successful weaning was 0.903,＜0.275 cm was used to predict successful weaning,and the sensitivity and specificity were 80.0％ and 89.6％,respectively.Conclusion The fight △DE30-10 measured using ultrasound can serve as an assistant index in predicting successful weaning from mechanical ventilation during SBT.

Objective To research the performance of micro infiltration type lung adenocarcinoma (MIA) in the low -dose CT (LDCT).Methods The clinical data of 34 patients with lung adenocarcinoma who found by LDCT screening and diagnosed as micro infiltration were retrospectively analyzed, LDCT performance of lesions was observed.Results In 34 patients,32 cases of single grinding glass tubers,2 cases of multiple ground glass nodules (2 and above),a total of 36 nodules.With pure glass grinding nodule in 11 (30.5%),mixed grinding glass nodules 25 (69.5%).Lesions was 0.7 -2.4cm in diameter,the diameter was about 1.0 -2.0cm,a total of 27(75.0%),an average of (1.7 ±0.3) cm.5(13.8%) of left upper lobe,left lung lobe 9(25.0%),6(16.6%) of the upper lobe, right lung middle in 8(22.2%),characterized by lower lobe in 8(22.2%).Radiographic signs included air -20 cases (55.6%),fine bronchiectasis sign clear edge in 22(61.1%),Ye Zheng a total of 29(80.6%),including deep lobe 9(25.0%),shallow lobes 20(55.6%),burr 17(47.2%),pleural indentation 20(55.6%).Bronchus truncation 6(16.7%),vascular cluster 9(25.0%).Conclusion Found in LDCT screening between 1.0 -2.0cm in diameter of grinding glass nodules,especially the grinding glass nodules,quantitative classification is higher at the same time, lesion boundaries clear,or points Ye Zheng,burr,air -with fine bronchiectasis and pleural indentation,micro infiltra-tion is characteristic and highly suggestive of lung adenocarcinoma.

ced glutathione in MHD patients appears to be associated with an improvement of oxidative stress.

Objective To investigate the serum cystatin C (CysC) level and explore its relationship with cytokines and atherosclerosis (AS) in maintenance hemodialysis (MHD) patients.Methods A total of 110 stable MHD patients undergoing hemodialysis for at least six months and 60 healthy control people were enrolled in the study.Serum levels of CysC and high-sensitivity Creactive protein (hsCRP) were measured by immunoturbidimetry.The serum levels of total homocysteine (tHcy),IL-1β,IL-6 and TNF-α were determined by ELISA.Prevalence of atherosclerosis was detected by carotid ultrasonography.The relationship of CysC level and cardiac geometry incidence in MHD patients was analyzed by Logistic regression model.Results The serum CysC level was significantly higher in MHD patients as compared with healthy controls [(6.19±0.95) mg/L vs (0.76±0.21) mg/L,P＜0.01],and the serum levels of hsCRP,tHcy,IL-1β,IL-6,TNF-α were significantly higher in MHD patients than those in healthy control group (P＜0.05 or P＜0.01).The serum CysC level was higher in MHD patients with carotid artery atherosclerosis compared to patients without carotid artery atherosclerosis (P＜0.05).CysC was positively correlated with hsCRP,tHcy,IL-1β,IL-6,TNF-α respectively (P＜0.05 or P＜O.01),and was positively correlated with carotid intimal medial thickness (IMT) and AS.Besides,a negative correlation was found between the serum CysC level and the serum albumin level (P＜0.05),while CysC was positively correlated with dialysis duration,systolic pressure and iPTH (P ＜0.05).Conclusion Serum CysC level is significantly higher in MHD patients and is correlated with hsCRP,tHcy,IL-1β,IL-6,TNF-α as well as carotid artery atherosclerosis,which indicates that CysC is an independent risk factor of AS in MHD patients.

Objective To investigate the effect of L-carnitine on pathological changes of myocardium and the underlying mechanism in chronic renal failure rats (CRF). Methods A total of 55 male SD rats were randomly divided into sham group (n=10),model group (n=15),low dose (300 mg/kg),medium dose (600 mg/kg) and high dose (900 mg/kg) L-carnitine group(n=10,each).5/6 subtotal nephrectomy was performed in these rats without sham group.One week after the operation,normal saline or corresponding dose L-carnitine were intragastrically administrated to sham and model group or L-carnitine groups for 17 weeks.Transthoracic echocardiography,mean arterial pressure (MAP),heart rate (HR) and heart weight/body weight were assessed.Moreover,24h urine protein,renal function,SOD,MDA,IL-6,ATP,ADP were measured at the end of the study.Additionally,pathological changes in myocardium were detected by light microscope and transmission electron microscope. Results (1) ATP (μmol/g·wt)in L-carnitine groups (2.35±0.24,3.59±0.28,3.78±0.25) was significantly higher than that in model group (1.61±0.12) (all P＜0.01).(2) Thickness of posterior wall of left ventricle (mm) in high dose L-carnitine group was thinner than that in model group (3.74±0.23 vs 4.18±0.48,P＜0.05). (3) The ratios of heart weight to body weight in both medium dose and high dose L-carnitine groups (3.92±0.27,3.65±0.2) were significantly lower compared to model group (3.99±0.27) (all P＜0.01). (4) Under light microscopy,disarrangement and hypertrophy of cardiac myocytes,increased myocardial fibrosis were observed in model group, while these changes and the pathological scores were significantly improved in both medium dose and high dose L-carnitine groups (7.14±1.07,6.13±0.99),as compared with model group (9.88±1.13) (all P＜0.01).Under electron microscopy,typical changes in cardiac hypertrophy were observed,including dissolution of myocardial fibers,increasing and swelling of mitochondria,membrane rupture as well as matrix increase in model group,while these changes were ameliorated by L-carnitine in a dose-dependent manner. (5) Seventeen weeks after the treatment,both IL-6 and MDA were decreased in all L-carnitine-treated groups than those in model group [IL-6 (ng/L):261.86±13.18,240.12±18.7,233.34±36.88 vs 596.64±81.41; MDA (nmol/L):15.23±2.01,12.41±0.6.10.97±1.9 vs 21.84±2.71).Whereas,SOD (U/ml) were increased in L-carnitine-treated groups (51.2±6.11,58.51±5.52,60.63±6.94) than that in model group(32.01 ±5.69 )(all P＜0.05).(6) No significant differences of systolic,diastolic blood pressure or MAP were found among groups. Conclusion L-carnitine can improve energy metabolism,micro-inflammation and oxidative stress in myocardium of CRF rats,which may be associated with the amelioration of cardiac hypertrophy and fibrosis.

Objective To investigate the expression and clinical significance of myeloid cell leukemia-1 (MCL-1) and F-box and WD repeat domain-containing 7 (FBW7) in breast cancer polyploid induced by spindle poisons. Methods (1) Nocodazole spindle poison was used to treat breast cancer cell MDA-MB-231. The morphological changes of cells were ob?served under microscope, and cells were harvested in 0, 6, 12, 24, 48 and 72 h. The cell cycle and DNA-ploidy changes were examined by flow cytometry. The expressions of FBW7 and MCL-1 proteins were detected by Western blot assay. (2) A multikinase inhibitor (Sorafenib) with Nocodazole or Taxol was used to treat MDA-MB-231 cells. MCL-1 protein expression was detected by Western blot assay after 48 h treatment. The cell cycle and DNA-ploidy changes were examined by flow cy?tometry after 48 h treatment. MTT method was used to observe cell proliferation after 48 and 72 h treatment. Results (1)Af?ter treatment by Nocodazole, polyploid characteristics of large cell size and nucleus were appeared. The percentages of octa?ploid were (0.8±0.2)%, (8.5±2.3)%, (7.8±2.0)%, (9.9±0.9)%, (28.2±0.8)%and (35.1±4.9)%after 0, 6, 12, 24, 48 and 72 h treatment, showing the increasing trend in turn (P<0.001). The number of polyploidy (tetraploid and octaploid) cells was as high as (97.6±0.7)%after 48 h treatment. The expression level of FBW7 protein was decreased significantly but the expres?sion of MCL-1 protein was increased significantly after 48 h treatment. (2) After 48 h treatment, the expression level of MCL-1 protein, polyploidy percentage and cell proliferation decreased significantly in Nocodazole+Sorafenib group and Taxol+Sorafenib group compared with those of Nocodazole group and Taxol group (P<0.05). Conclusion The lower expression of FBW7 protein and over-expression of MCL-1 protein are correlated with the formation of breast cancer polyploidy. Sorafenib can reduce polyploid tumor cells by inhibiting MCL-1 protein expression.

Objective To investigate the effects of SPARC (secreated protein acidic and rich in cysteine) and its peptide on proliferation, apoptosis and cell cycle of human mesangial cells cultured in vitro, and explore the possible mechanism. Methods Mesangial cells were incubated in the media with various concentrations of SPARC and its peptide cultured in vitro. Cell proliferation was assessed by MTT colorimetric assay. Cell cycle and apoptosis index were analyzed by flow cytometry. The expression of cyclinD1 and p21Wafl proteins in response to SPARC and its peptide in HMC was determined by Western blot. Results Various concentrations of SPARC and its peptide could significantly inhibit the proliferation of mesangial cells in dose- and time-dependent manner, regulate the cell cycle at phrase G-0/G1 increased while cells phrase S reduced, and could also induce apoptosis. Under the stimulation of SPARC and its peptide, the expression of cyclinDl in HMC decreased markedly meanwhile the expression of p21Wafl increased significantly. Conclusions SPARC and its peptide can effectively inhibit HMC proliferation and regulate cell cycle progression. The mechanism may be mediated by inhibiting cyclinDl and stimulating p21Wafl expression, subsequently blocking cells passing through G-S check point, which will be useful for treating mesangial proliferative glomerulonephritis.

Objective To investigate the serum level of free fatty acid (FFA) and explore its relationship with cytokines and atherosclerosis (AS) in chronic kidney disease (CKD).Methods The serum level of FFA was determined with enzymatic colorimetry.IL-1 β, IL-6 and TNFα were determined with ELISA.High-sensitivity C-reactive protein (hsCRP) was measured with immunoturbidimetry.Prevalence of atherosclerosis was detected with carotid ultrasonography.We evaluated the relationship between serum levels of FFA and IL-1β,IL-6, TNFα, hsCRP as well as the renal function in 130 adult patients with CKD, stratified according to the GFR ( based on the National Kidney Foundation/Kidney Dialysis Outcomes Quality Initiatives) and in 58 hemodialytic (HD) patients.The relationship between FFA level and cardiac geometry incidence in CKD patients was analyzed with logistic regression model.Results The serum level of FFA was significantly higher in CKD patients as compared with that in the healthy controls [(492.63 ± 143.59)vs (302.65 ± 142.18) μ mol/L, P ＜ 0.01], even in the early stage of CKD.The level of FFA increased with the progression of renal dysfunction.In the non-dialytic CKD group, the level of FFA was negatively related to GFR and positively related to the proteinuria (P ＜ 0.05), while in the HD group, it was positively correlated with dialysis duration ( P ＜ 0.05 ).The serum levels of FFA were higher in CKD patients with carotid artery atherosclerosis than those in patients without ( P ＜ 0.05 or ＜ 0.01 ).However, in both groups with impairment of renal function, the levels of FFA were positively correlated with hsCRP, IL-1 β, IL-6,TNFα and TG( all P ＜ 0.05 ).A positive correlation between the level of FFA and the clinical manifestations such as carotid intimal medial thickness (IMT) and AS was also found.A negative correlation was found between the level of FFA and the serum level of albumin and GFR( P ＜ 0.05).Conclusion Serum levels of FFA are significantly higher either in non-dialytic CKD or in HD patients and it is related with hsCRP, IL-1 β, IL-6, TNFα as well as carotid artery atherosclerosis, indicating that FFA is an independent risk factor of AS in CKD.